Opinion

So Far, So Good: Explaining Britain’s Vaccination Success

“Dear British, we envy you,” read the cover of Bild, Germany’s best-selling newspaper, on 24th February. It’s clear why. Adjusted for population, the UK has given three times as many vaccinations as most of its European neighbours and continues to vaccinate at three times their rate.

A key reason for the UK’s success is that it ordered vaccines very quickly. For instance, it signed with AstraZeneca three months before the EU. Kate Bingham, the head of the UK Vaccine Taskforce, told La Repubblica about another company: “We had our first meeting on a Thursday and we had a follow up meeting on [the] Saturday, and we would agree the rough outline of a deal the following week.” Bingham herself has known the Chief Business Officer of BioNTeach for 20 years, “so it’s very easy for me to just pick up the phone and have lunch with him a year or two ago when he was in London, easy for me to pick up the phone and have those conversations.”

Some criticised Bingham’s appointment as Conservative cronyism – she is the wife of a Conservative minister, there was no clear appointment process, and as a venture capitalist, she had no civil service experience. But cronyism or not, her team was quick to make deals.

Ministers were then quick to approve them. Bingham explained, “If I called [the Secretary of State for Business, Health, Cabinet Office or Treasury] and said we need to have a decision on this in 24 hours, we had a decision in 24 hours. I think that is unusual.” Dominic Cummings, the Prime Minister’s former chief advisor and ever a critic of Whitehall, agrees. He recently said that “we had to strip away all the normal [Department of Health] nonsense” for the vaccine programme to succeed.

Much of that “nonsense”, of course, is the important business of protecting taxpayer money and ensuring good value. However, the UK does not seem to have paid an inflated price for the vaccines themselves. Oxford partnered with AstraZeneca on the promise that they would sell the vaccine without profit, Johnson & Johnson claims to be doing the same, and Bingham reckons the UK paid a similar amount to the US for the others.

The difference is that the UK committed a lot of money before the vaccines were known to be safe and effective. Airfinity, a data analytics firm, estimates that the UK committed €1.9bn of so-called risk money to pharmaceutical companies. The entire EU committed just €1.78bn.

This commitment came in many forms. Take the example of Novavax. The British government bought equipment so it can be manufactured in Teesside. It also launched an NHS page allowing people to register their willingness to take part in clinical trials, helping Novavax’s Phase Three trial to finish in Britain before it even started in America.

This support has reaped rewards. It’s why AstraZeneca has not diverted doses from the UK supply chain to the EU, even though the EU has only received a third of the doses initially expected. Pascal Soriot, the CEO of AstraZeneca, told La Repubblica that in return for the UK’s risk money, “the UK government said the supply coming out of the [AstraZeneca] UK supply chain would go to the UK first.” Bingham put it more gently, explaining, “We tried to make ourselves good customers to make people want to supply the UK” when initial supplies were limited.

Why was the EU slower and why did it commit less risk money? Economist Paul Krugman argues in the New York Times that “European officials were not just risk averse, but averse to the wrong risks.” They were worried, he thinks, about paying too much or committing to ineffective or dangerous vaccines, when they should have been worried about Europeans getting sick or dying because the vaccine rollout was too slow. 

Bingham disagrees with Krugman. She thinks that, in the end, the EU’s liability claims were probably very similar to the UK’s, “we just got to that position maybe sooner than others.” Perhaps that reflects the complexity of finding agreement among 27 countries.

Having signed the contracts, the vaccines needed regulatory approval. The British regulator approved the Pfizer vaccine 18 days before the European regulator, giving the British rollout a head start. This is because they gave temporary, emergency approval of specific batches of the vaccine, whereas the European regulator gave a broader “conditional marketing authorisation”. Gudio Rasi, the former head of the European regulator, criticised the British regulator for not doing “a robust review of all available data”, which the British regulator and government strongly refuted. Nevertheless, this debate is peripheral to the success of the rollout. The 18-day head start does not explain why, three months later, the UK is still vaccinating so much quicker.

More importantly, the British regulator also diverged from its European counterpart by approving a 12-week gap between doses. Had second doses not been delayed, only half of the top four most vulnerable cohorts would have been vaccinated by mid-February, according to The Financial Times. At the time, The Guardian articulated the “surprise” of Pfizer and the British Medical Association that they were “approving a regime that was not trialled” – but data from the UK has subsequently confirmed the logic behind the decision: the vaccines give good protection after just one dose.

The British regulator had the confidence to make this decision, in part because support for vaccines in Britain is much higher than in Europe. According to a recent YouGov poll, 86 per cent of Brits say they will take or have already taken the vaccine, compared to just half of people in France. Figures in other European countries are not much higher.

There are diverse reasons for vaccine hesitancy in Europe. In France, it stems back to 2009. The government overspent on swine flu vaccines which ultimately went unused, fuelling the accusation that the government was “in cahoots with Big Pharma”. By contrast, in Eastern Europe, distrust of the intentions of those in power is perhaps a legacy of the Soviet era. Unicef also worries that the success of their compulsory routine vaccination programmes has desensitised people to the need for vaccines.

Whatever the cause, vaccine hesitancy has hindered the European rollout. For example, to mitigate concerns, France required repeated and time-consuming medical visits to care home residents to ensure they gave informed consent before getting vaccinated. That’s why, at the end of February, it had only administered 273,000 of the 1.7 million AstraZeneca doses it had to hand. President Macron’s false claim that the AstraZeneca vaccine is “quasi-ineffective” among older people did not help either.

Vaccine hesitancy is also one of the reasons why a dozen European countries paused the use of the AstraZeneca vaccine upon reports of blood clots among a very small number of recipients. The plan was to reassure hesitant citizens: we monitor these vaccines rigorously and only give them to you when we are certain they are safe. For better or for worse, Brits have generally needed less reassuring.

They have, however, been reassured by the NHS. Under the direction of Sir Simon Stevens, the boss of the NHS, GPs have given three-quarters of injections, outpacing the new, large-scale vaccination hubs. This decision to use existing infrastructure, expertise and relationships helped to avoid teething issues. It also contributed to the remarkable 90 per cent uptake among older people. Beccy Baird, a senior fellow at the King’s Fund thinktank, explained to The Guardian that it’s because GPs “know their community”. She noted that Israel and Britain – whose vaccine programmes are both world-leaders – both have very strong GP networks.

Of course, the vaccine programme has a long way to go and there are still many unknowns. Will the EU join India in suspending vaccine exports? What will the uptake be among younger people? And how successful will the autumn booster programme be, with vaccines adapted for the new variants of the virus?

Time will tell – but so far, Britain’s vaccine programme has performed enviably.

Image Credits: Pixabay